What are things worth?

AM didn't come today. He had a confirmed appointment. However, his wife came without him to his appointment just to talk with me about his condition. This is a sensible idea, and it's good care. AM has dementia and there isn't really that much that I need to see him for. Mostly I need to help his wife to take good care of him. However, this is a medicare issue. Medicare doesn't allow billing for "family conference" with outpatient care. That's a silly thing, but that's what they do. So people have to pay for that themselves. I don't mind the conferences, but I mind not being paid for things, so I tell people that they'll have to pay for it without medicare. Usually, they don't want to have the conference if they have to pay for it. Of course, that's what Mrs.M chose to do. She "can't do that". The charge for that service is $80. This is a little less than what medicare pays for a patient visit. It is $10 less than what I am charged to clean out my dryer vent once a year. I'm not sure how we can fix a "broken health care system" under these circumstances. If the patient's wife "can't do that" (spend $80 for a consultation about how to take care of her husband) when that costs less than what most people who smoke spend on cigarettes, then we have a problem. There is a huge difference between what people are willing to TAKE and what people are willing to SPEND in terms of health care. I don't think that the service in question is worthless. However, my thoughts on the matter are irrelevant. Things are only worth whatever the market will bear. If no one will pay for whatever it is then whatever it is isn't actually worth anything, regardless of what your thoughts are on the matter. My new dog needs hip surgery (dysplasia). The vet said it would be about $500. To me, it's worth more. I don't know how he came up with his fee schedule for that procedure, but I'm very happy to pay what he's asking (I'd pay more, but I didn't offer that to him). Since I'm willing to pay him what he wants it's worth $500. On the other hand, if he were charging $2,000 (which I think a lot of Vets do) then (in my case) it would be worth $2,000. Of course, he'd do less operations (some people just "can't do that") so he could end up making less.
Next year, medicare will pay $150 for a new patient visit for a physician (it's $225 this year). That means that a new patient visit will be "worth" $150 next year. How did that visit lose all of this value this year? It's worth whatever medicare says it's worth as long as I continue to take medicare. I take medicare because if I don't I can't practice in this town and I don't want to leave. I take medicare because right now, I still make more than I could doing something else with my training. However, that is very rapidly changing. Soon, I will be able to make more by working at Publix. At that point, it will become more difficult to explain to my family why I am doing what I am doing. Next year, a lot of physicians will stop practicing because it isn't "worth it". I will still do it, but I still like being a doctor very much. I haven't had to cut down my patient visits to five minutes and see forty people a day yet. The guys who have already done that just don't have any more cushion left. They also don't like being doctors anymore.
Worth is very funny, and very complicated.